Dealing With Dementia

Diagnosing And Treating One Of The Most Frightening Ailments Of Aging Adults



Dementia Warning Signs

Among the aging population there is one thing that scares people more than cancer or even death itself—dementia. Although there are many types of dementia, 60-to-80 percent of all cases are Alzheimer’s disease. The Alzheimer’s Association estimates that more than five million Americans have Alzheimer’s. As the Baby Boomer generation ages, that number is expected to triple by 2050. And we all want to know, what can we expect?

DIAGNOSIS AND TREATMENT
“Many people think that you’re going to get dementia just because you get older,” says Dr. Marissa Galicia-Castillo of Eastern Virginia Medical School. “That’s not true. The truth is that some kind of pathology causes dementia, whether it’s Alzheimer’s dementia or stress causing vascular dementia.”

Another misconception is that all dementia is irreversible. While that is 
true for the vast majority of cases, there are exceptions. But in those cases, symptoms will persist if the patient remains untreated.

“When someone comes in with signs of dementia,” says Dr. Castillo, “the first thing we do, as far as the workup, is to see if they have anything that is reversible. About 10 percent are vitamin deficiencies, infections, structural things. Also, if someone is depressed, they can likewise appear demented.”

In cases where the prognosis is irreversible dementia, treatment is still available. Dementia progresses through three phases, from mild to moderate to severe, and it is possible to temporarily stave off this progression through the use of medication.

“The classic forms of dementia medication are Aricept, Exelon and Namenda,” says Dr. William Hovland of Granby Internal Medicine and Geriatrics and Long-Term Care of Virginia. “Those three are the treatments that are available to slow the course of the illness. They make some people better—not everybody—but they do slow the progression of the disease.”

People with a family history of dementia can perform preventive actions. “Brain health is the issue,” says Dr. Hovland. “What’s good for your heart—exercise, monitoring cholesterol levels—is good for your brain. It’s been shown multiple times that people with a vigorous lifestyle do better cognitively than people who have a sedentary lifestyle.”

WARNING SIGNS
It’s happened to all of us one time or another: halfway down the stairs we can’t remember what we were going down for in the first place. But recall problems as you get older aren’t necessarily a sign of dementia, nor are typical moments of forgetfulness. “Anyone can lose their keys,” says Dr. Castillo. “You might have misplaced them somewhere in the house or dropped them without realizing it. Concern comes when things are out of proportion from what you expect. For example, if you put your keys in the refrigerator. Or you put the iron in the refrigerator.”

To help distinguishing symptoms 
of dementia from normal behavior, 
the Alzheimer’s Association provides 
this list of 10 warning signs:
1 Memory loss that disrupts daily life
2 Challenges in planning or solving problems
3 Difficulty completing familiar tasks
4 Confusion with time or place
5 Trouble understanding visual images and spatial relationships
6 New problems with words in speaking or writing
7 Misplacing things and losing the ability to retrace steps
8 Decreased or poor judgment
9 Withdrawal from work or social activities
1 0 Changes in mood and personality

BECOMING SOMEONE ELSE
“My mother,” says Newport News resident Ann Shalaski, “was a lady who seldom left her house without her hair fixed, without having jewelry on, without being just right. She took great pride in that. She would bring her pocketbook and a clean hanky even to go to the grocery store. I was visiting one time, waiting in the living room for her to get dressed. When she came out of her bedroom, she had on a brown top with a pair of blue slacks. The buttons were gone on the brown top and safety pins were keeping it closed. This was autumn in Connecticut, but she had a pair of black sandals with little heels, patent leather, the kind you would wear at Easter. Part of the heel was broken and was coming loose. She took Scotch tape and she taped the shoe and put it on her foot. It really doesn’t sound like a lot, but that was the curve in the road that made me know that things would never be the same again. This was her new way of thinking, her new way of living, her way of fixing a problem to make something work for her. It was like she was becoming someone else.”

Shalaski and her family wavered on whether or not to remove their mother from the comfort and familiarity of her apartment and place her in a safe, restrictive environment. This, after all, was their mother, and she didn’t want to go anywhere. Eventually, there was no choice.

“One day,” says Shalaski, “my mother left her apartment about three in the morning and took the elevator. She went out the front door in her nightgown in Connecticut to rescue a baby that she could see from the window. But there was no baby. And since she lived in a secure place, she was locked out of the building and couldn’t get back in. She wandered around the parking lot until the building’s maintenance man came to work and found her. She could have died out there in the cold in January.”

OPTIONS
When someone can no longer live alone safely, they may need to move to an assisted care facility, which provides things like cooked meals, nursing treatment, in-room doctor visits, and assistance with dressing, grooming and getting to the bathroom. But treatment like that is expensive. and unless it’s covered by long-term care insurance, the costs will come out of pocket.

Even if you decide to move a parent into your home to care for them yourself, the costs can be enormous. A RAND Corporation study found that the annual cost of caring for a dementia patient was between $41,000 and $56,000. There are also difficult decisions to be made. If your father gets dementia, do you stay home to care for him and make sure he’s safe, or do you go to work to earn money to pay for his care?

In recent years, new services have sprung up to help share the burden. Multiple adult day care services are listed throughout Hampton Roads. The state-sponsored program PACE (Program of All-inclusive Care for the Elderly) allows individuals to remain living at home while receiving the requisite medical and social services. People can be dropped off at one of the four Hampton Roads centers or a van can come to pick them up at their homes. To be eligible, individuals must be 55 years of age or older and be pre-screened by an authorized physician or screening team.

“NO” IS A BAD WORD
Coping with a loved one who has dementia can be difficult because it is nearly impossible for them to communicate to you what they really want to. They can lash out in anger unless you utilize coping mechanisms to handle 
the situation.

After her mother settled into an assisted-care facility, Shalaski was surprised on one of her visits. “Being the proverbial hostess that my mother was,” says Shalaski, “she opened the armoire and said, ‘There really isn’t a lot in the refrigerator, but tell me what you’d like and I’ll get it for you.’ Your impulse and your instinct is going to be to correct her, but “No” is not a good word. Instead, I said, ‘I don’t really see anything here that I like. Let’s walk down to the community room and get some ice cream.’ That technique is called Capture and Lead. You capture them and lead them away. But it’s hard to suppress what a normal person would do: You want to say, ‘That’s not a refrigerator.’ But I had to realize it is a refrigerator. It’s her refrigerator.”

Editor’s Note: Advice on Eldercare is a yearlong series of articles dealing with caring for aging parents and relatives.